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Melanie Stengel :: C-HIT.ORG

Thomas Burke, his wife Gretchen Wright and the emotional support dog Rosie. Burke says Wright and Rosie are an important part of his recovery. Burke is the co-founder of High Ground Veterans Advocacy, which calls on veterans to champion local, state and national politics. He is a pastor at Norfield Congregational Church in Weston.

Food makes Thomas Burke nauseous. Burke, an ex-Marine, does not eat in front of people because he is likely to vomit. He barely takes his meals and never finishes what is on his plate.

He battled anorexia and bulimia at different times for over a decade, and like many other veterans with eating disorders, he credits them to his time in the military.

Burke, of Weston, said in basic training for his Marines, drill instructors don’t eat in front of the troops, which he saw as a message that eating is a weakness. In Iraq and Afghanistan, he went days without eating while focusing on military missions. In Afghanistan, he saw children blow themselves up by a roadside bomb, and he had to pick up their body parts. This triggered a suicide attempt, long-standing suicidal ideation, and post-traumatic stress disorder (PTSD). He saw himself as someone who “didn’t deserve to eat,” he said.

Veteran eating disorders are associated with exposure to trauma and pressure to meet military weight and fitness demands, said Dr. Sara Rubin, psychiatrist who heads the Disorders Program. supply to VA Connecticut Healthcare. Additionally, women who have been sexually assaulted in the military are prone to eating disorders, she said.

According to Robin M. Masheb, psychologist at Yale Medical School and researcher for the US Department of Veterans Affairs (VA), “many veterans seem to struggle with their diet and body image, but go unrecognized.”

A study of veterans after 9/11 found that bulimia, binge eating, and atypical anorexia nervosa (AAN) were associated with depression, anxiety, PTSD, insomnia and to a lower quality of life. The ANA exhibits symptoms of anorexia, including starvation and extreme fear of weight gain, but without dangerous weight loss. Masheb’s study of over 1,100 veterans was the first to examine the AAN in veterans. It found that 14% of women and 5% of men had probable NAA, “a clinically significant eating and mental health disorder.” The study also found that 6% of women and 3% of men suffered from bulimia (cravings and purges), three times the rate of civilians.

Eating disorders can also lead to death. A study by Deloitte Access Economics found that 10,200 people die each year from an eating disorder. Anorexia nervosa has the second highest death rate of all psychiatric disorders after opioid use disorders, and one in five deaths among people with anorexia is suicide, according to National Eating Disorders Association.

The VA Eating Disorders Program was established in 2019, shortly before the start of the COVID-19 pandemic, affecting attendance, Rubin said. Patients should be referred by clinicians, who often fail to detect signs of eating disorders, especially in overweight patients, she said. So far, 29 men and 26 women have been referred. Services include diagnosis, remote group sessions, cognitive behavioral therapy, nutritional counseling, psychotherapy and medication.

Yale School of Medicine

Robin Masheb’s study was the first to examine atypical anorexia nervosa in veterans.

Masheb, director of the VA’s National Veterans Diet and Weight Initiative, said eating disorders have been masked in military and veteran populations because most of the research is are focused on white, adolescent girls and young women, leading to mistaken beliefs that men, older and overweight women and people of color do not have eating disorders.

Masheb is working on several studies focusing on eating disorders. They include devising mechanisms for the VA to detect eating disorders in patients, which it does not currently do; determine appropriate treatments for veterans with binge eating disorder; separate the treatment of binge eating and bulimia in the military from weight management; and train VA providers to identify eating disorders.

The Connecticut National Guard has created a fitness improvement program to help soldiers struggling with weight and fitness, according to spokesperson Capt.David Pytlik. He said he focuses on sleep, nutrition, mental health and exercise, adding that if a soldier’s eating habits raise concerns, they are referred to behavioral or medical doctors.

Burke said veteran women told him they starved themselves before the military weigh-ins and struggled to regain the required weight after giving birth. He knows people who added muscle by weight training and who were considered overweight. He called for a change in military culture so that personal care, including nutrition, is valued.

Masheb led a study that showed a relationship between changing eating habits to meet military weight standards and binge eating and eating pathologies later in life. The study reported that nearly 24,000 soldiers were demobilized between 1992 and 2006 for exceeding maximum body fat limits.

Burke was diagnosed in the VA with an eating disorder about four years ago, but the focus was on his physical health and did not include mental health care. He now sees a private therapist who deals with the psychiatric issues and physical needs associated with eating disorders.

“I’m in a better position, but I’m still struggling a lot,” he said.

It has been a journey. After returning from the military, he tried to eat more, but he didn’t know how. “I couldn’t regulate my food intake,” he said. He became bulimic, eating all of his groceries at once, then vomiting. When he was a wrestler at the University of the Sacred Heart, he repeatedly broke and fractured fragile ribs due to malnutrition. The pain scared him and made him want to learn how to eat properly and build muscle by weightlifting. He said his starvation was partly related to a desire to be thin, a hallmark of anorexia.

“My feelings about what I deserve have a lot to do with eating and taking care of myself, doing what I need to do to be happy,” Burke said. His wife has used trial and error to find foods that appeal to her. He also drinks protein shakes.

At 5ft 7in, he now weighs 150 pounds, down from a low of 120. And at 32, his life is busy. He is a graduate of Yale Divinity School and is Associate Minister for Children, Youth and Families at Norfield Congregational Church in Weston. He is the co-founder and treasurer of High Ground Veterans Advocacy, which trains veterans to advocate on veteran issues. He got married last year. He said his wife, Gretchen, had helped him “get back to better health, mentally and physically” and that his service dog, Rosie, calmed his anxieties.

Burke recently suffered a setback when the Navy Discharge Review Board rejected his request to upgrade from Non-Honorable (OTH) to Honorable Discharge. He said his release status was based on the use of marijuana after the children died in Afghanistan. OTH is “absolutely connected” to feeling “a person who doesn’t deserve to eat,” he said with tears in his eyes.

For help with eating disorders, contact Nationalatingdisorders.org.

This article was originally published on November 3, 2021 by the Connecticut Health Investigation Team.